N.Y. Psychiatrists Recount How Sept. 11 Changed Their Lives

The bad news was that so few people were injured.

There was no good news.

On September 11, 2001, most psychiatrists in New York, like most other people there and around the world, first learned of a plane crashing into the World Trade Center from someone else—a secretary, a colleague at work, a spouse, a friend.

Any thoughts that the event might have been an accident were dispelled after another plane struck the second tower.

Eight years earlier, terrorists had set off a truck bomb in the underground parking garage in the World Trade Center, an event that led to increased preparations for disaster in New York.

"St. Vincent's received several hundred injured people in 1993, so we again anticipated a large number of injured," said psychiatrist Spencer Eth, M.D., who then worked at St. Vincent's Hospital, the closest major trauma center to the World Trade Center.

St. Vincent's cancelled all elective surgeries that September morning, discharged all patients who could go elsewhere safely, and cleared its emergency room, said Eth in a recent interview with Psychiatric News.

"We didn't know the cause of the crash immediately, but any fire in a high-rise building is bad news," he said. "We thought it would be a medical/surgical disaster."

In the hospital's command center, Eth watched the towers collapse on television.

"That changed everything," said Eth. "We knew that the people in the towers all died and that people not in the impact zone would survive. Adding to our shock was the realization that all our preparations were in vain."

The anticipated medical emergency soon turned into a mental health disaster.

"People came to the hospital in distress, looking for friends and families. They were grief-stricken, anxious, panicked, seeking assurance," Eth noted.

Farther uptown at Mount Sinai Medical Center, Craig Katz, M.D., was in his second week as director of the psychiatric emergency department. In the midst of morning rounds, he took a call from his colleague Anand Pandya, M.D., telling him about the attack. Katz and Pandya had cofounded Disaster Psychiatry Outreach in 1998 to prepare psychiatrists to provide volunteer care following disasters.

These and other hospitals soon set up family-assistance centers, which were consolidated within days at the New York City Armory at Lexington Avenue and 26th Street. Disaster Psychiatry Outreach played a major role in serving the mental health needs of family members who came to the armory seeking news of loved ones, social services, financial assistance, or emotional support.

"We had hundreds of documented informal encounters with families," Pandya recalled. "We also did formal psychiatric evaluations on 848 individuals between September 12 and November 20, when the center closed."

Anthony Ng, M.D., was the medical director of Disaster Psychiatry Outreach and supervised the volunteer psychiatrists at the armory. Because of his involvement with Disaster Psychiatry Outreach and as president of New York City's Voluntary Organizations Active in Disasters, he already knew members of the city's crisis-response team and the Federal Emergency Management Agency.

"Understanding the disaster response structure and taking part in the planning process is a critical factor in coordinating the mental health response to any disaster," said Ng in an interview.

Psychiatrists Sent to Ground Zero

Disaster Psychiatry Outreach also sent psychiatrists to ground zero, the smoking rubble that was once the World Trade Center towers.

"This was nothing remotely approaching two chairs in a room," said Katz. His organization helped train volunteer psychiatrists and screen their credentials. Training was more than clinical.

"We oriented people to the disaster-response system and explained who the major agencies were and how to work in a collegial way with them," he said.

Katz worked at ground zero too. "I'd go up to workers, but I wouldn't introduce myself as Dr. Katz," he said, although his I.D. badge indicated he was a physician. "I'd just introduce myself by my first name and ask how things were going."

Most of the workers wouldn't talk about themselves, but would open up about how coworkers or their families were coping. Katz presumed that in some masked way, they were talking about themselves.

Workers expressed a lot of rage at the hijackers. "Was it OK to be angry?" one asked him.

Informal Psychoeducation Was Critical

Psychoeducation was the order of the day. Katz suggested that the workers call their families often, not work too many shifts in a row, and refrain from drinking too much.

None of this was formal psychiatry, but Katz kept brief, anonymous notes, which today he wishes were more extensive.

Credit: AP Photo/Mark Lennihan

The world has changed a lot since that September day 10 years ago. People have moved on, but they have not left that day behind.

Pandya is vice chair of psychiatry at Cedars Sinai Medical Center in Los Angeles and an associate clinical professor at UCLA. He does less disaster psychiatry these days.

"September 11 was a turning point," he explained. "The mainstream of psychiatry started thinking about disaster psychiatry. There is now a shelf load of books on the topic. It's hard to keep up with the literature, not to mention the neurobiology of stress disorders and traumatic brain injury."

Katz is still at Mount Sinai, an associate clinical professor of psychiatry. His current work encompasses more than lower Manhattan now. "I'm working more internationally to develop ways to build up mental health systems not only in New York, but also in Belize, Liberia, and Sri Lanka."

Ng is now medical director of the psychiatric emergency department at Acadia Hospital in Bangor, Maine.

"I think about 9/11 often and wonder how that day and the following days have affected me," said Ng. "Because of that day, I am where I am professionally. I also have my wonderful family and the many friends and colleagues I have met since. But I still have difficulties watching September 11 movies. It's not like I have PTSD, but I don't want to relive it again—maybe it's a healthy kind of avoidance."

Eth is now director of mental health outpatient programs at the Miami Veterans Affairs Medical Center.

"Most people I know in lower Manhattan were emotionally affected—including me," said Eth. "Most recovered, but many did not. They really needed help for a long time. I certainly didn't forget it by moving to Miami. The soldiers we see in the VA now are also legacies of September 11."

"Services Provided by Volunteer Psychiatrists After 9/11 at the New York City Family Assistance Center: September 12-November 20, 2001" appears in the May 2010Journal of Psychiatric Practiceand is posted at <www.ncbi.nlm.nih.gov/pmc/articles/PMC3086595>.

Footnotes

• This is the first in a series of articles in Psychiatric News that will explore the mental health aftermath of the September 11, 2001, terrorist attacks.